Is folate really necessary?
Folate, also known as Vitamin B9, is one of the B vitamins required for human health. It is an essential vitamin, meaning that our bodies cannot make it on their own, so it must be acquired through diet.
In the mid 1900s, it started to become clear that folate deficiency was strongly associated with adverse outcomes in pregnancy, including neural tube defects (i.e. spina bifida). Decisions were then made at a public health level to try and reduce this risk factor in the general population. By the mid 1990s, this was accomplished through the mandatory fortification of the majority of grains sold in Canada and the United States with folic acid.
Since this time, some concerns have been raised about excessive levels of fortification, with labels not always reflecting true amounts of folic acid present in foods, and other concerns being raised about the specific form of folic acid being used in fortification.
As a physician regularly asked for my advice on folic acid supplementation, I take an individualized approach to every patient I see. We do a careful dietary review to assess how much folate is present in a patient’s typical diet as well as any supplements currently being taken. It’s also possible to measure a woman’s blood level for folate, which can help to guide her need for supplementation.
Recently, an article that was published in the journal Environmental Health Perspectives has led me to encouraging even those of my patients with the best of diets to consider supplementation. Here is what this study showed.
A link between pesticide exposure in pregnancy and the development of autism in offspring has previously been made in numerous studies. This study again showed this correlation. But what was of particular interest was that in women who had a higher intake of folic acid (over 800ug/day), the risk of pesticide exposure causing autism was essentially eliminated. So somehow folate was protective against what may otherwise have been a toxic exposure.
This isn’t the first time good nutrition has been found to decrease the risk of harmful exposures, but it is another great reminder of how important a healthy, whole food diet and select supplements can be in protecting the health of both mom and baby.
Ray, J. G. (2004). Folic Acid Food Fortification in Canada. Nutrition Reviews, 62. doi:10.1111/j.1753-4887.2004.tb00072.x
Shakur, Y. A., Rogenstein, C., Hartman-Craven, B., Tarasuk, V., & O'Connor, D. L. (2009). How much folate is in Canadian fortified products 10 years after mandated fortification? Can J Public Health, 100(4), 281-284.
Quinlivan, E. P., & Gregory, J. F. (2003). Effect of food fortification on folic acid intake in the United States. The American Journal of Clinical Nutrition, 77(1), 221-225. doi:10.1093/ajcn/77.1.221
Schmidt, R. J., Kogan, V., Shelton, J. F., Delwiche, L., Hansen, R. L., Ozonoff, S., . . . Volk, H. E. (2017). Combined Prenatal Pesticide Exposure and Folic Acid Intake in Relation to Autism Spectrum Disorder. Environmental Health Perspectives, 125(9), 097007. doi:10.1289/ehp604